Department of Critical Care Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada.
J Intensive Care Med. 2012 Sep-Oct;27(5):290-7. doi: 10.1177/0885066611402463. Epub 2011 Mar 25.
Fever is common among patients admitted to intensive care units (ICUs). In spite of the frequency of its occurrence, the biological mechanisms regulating the initiation and progression of fever are poorly understood. In addition, there are few large studies reporting on the epidemiology and etiology of fever in general medical and surgical ICU patients. Current evidence suggests that the development of high fever by patients admitted to ICUs with a medical admission diagnosis is associated with an increased risk of death. The decision to treat fever should therefore be obvious, but several lines of evidence argue against temperature-lowering strategies. Furthermore, the use of different temperature control strategies in febrile patients without acute brain injury or acute myocardial infarction is guided by a paucity of randomized clinical trials and by a lack of understanding of the biology of the induction and control of fever. As such, a review of the epidemiology, molecular mechanisms, and immunology of fever as well as the evidence behind management of fever in the critically ill is pertinent to all critical care practitioners.
发热在入住重症监护病房（ICU）的患者中很常见。尽管发热很常见，但调节发热发生和进展的生物学机制仍了解甚少。此外，很少有大型研究报告一般内科和外科 ICU 患者的发热流行病学和病因。现有证据表明，以内科诊断收治的 ICU 患者发生高热与死亡风险增加相关。因此，治疗发热的决策应该是明确的，但有几条证据反对降温策略。此外，对于没有急性脑损伤或急性心肌梗死的发热患者，不同的体温控制策略的使用是基于缺乏随机临床试验以及对发热诱导和控制生物学的理解不足。因此，对发热的流行病学、分子机制和免疫学以及重症患者发热管理的证据进行回顾，与所有重症监护医生都相关。
